HEALTH CARE SYSTEM

alma ata declaration

●​ Adopted at the International Conference on PRIMARY HEALTH CARE (PHC),held at

Almaty (Alma Ata),Kazakhstan (USSR) from 6-12 September 1978
●​ Organized jointly by the World Health Organisation(WHO) and the United Nations
Children's Fund (UNICEF)
●​ 134 State representatives ratified the WHO Declaration of Alma-Ata

Main Purpose/ Goals

●​ Declare health as a fundamental human right

●​ Achieve “Health for All” by the year 2000 and beyond.
○​ -Everyone, regardless of income, location, or status, should have access to the
highest attainable standard of health.
●​ Promote Primary Health Care as the key to achieving health for all
○​ -PHC should be accessible, affordable, acceptable, and involve the community.
●​ Reduce health inequalities
○​ -Address the gap in health status between developed and developing countries,
and within nations.
●​ Encourage community participation and intersectoral action
○​ -Health improvement requires cooperation between health sectors, education,
agriculture, housing, and other areas.
●​ Guide global and national health policies
○​ -Provide a framework for countries to shape their health systems toward fairness
and universal access.

Alma ata Declaration

“Health is a fundamental human right and that the attainment of the highest possible level of
health is a most important worldwide social goal whose realization requires the action of many
other social and economic sectors in addition to the health sector

The existing gross inequality in the health status of the people particularly between developed
and developing countries as well as within countries is politically, socially and economically
unacceptable and is, therefore, of common concern to all countries

The promotion and protection of the health of the people is essential to sustained economic and
social development and contributes to a better quality of life and to world peace

Government have a responsibility for the health of their people which can be fulfilled only by the
provision of adequate health and social measures

Primary Health Care

Primary health care (PHC) is an approach to health that provides essential, accessible, and
affordable health services close to where people live and work. It covers a broad range of health
needs including health promotion, disease prevention, treatment, rehabilitation, and palliative
care throughout a person's life. PHC focuses on comprehensive, community-centered care that
empowers individuals and communities, addresses social determinants of health, and integrates
multisectoral policies to promote equity and well-being

PHC is a "whole-of-society approach to health that aims at ensuring the highest possible level of
health and well-being and their equitable distribution by focusing on people’s needs as early as
possible along the continuum from health promotion and disease prevention to treatment,
rehabilitation, and palliative care, and as close as feasible to people’s everyday environment

Principle of Primary Health Care

1.Equitable distribution: Health care services must be distributed fairly and equally to all
individuals regardless of gender, age, social status, or location to reduce disparities.

2.Community participation: Communities must be actively involved in planning, organizing, and

managing their health care services, ensuring local needs and resources guide health initiatives.

3.Health human resources development: Adequate numbers of trained health workers,

distributed appropriately and supported within integrated teams, are essential for effective PHC.

4.Use of appropriate technology: Health technologies should be scientifically sound, affordable,

accessible, feasible, and culturally acceptable to communities.

5.Multisectoral approach: Health improvement requires cooperation beyond the health sector,
including agriculture, education, housing, sanitation, and community organizations, to address
social determinants of health comprehensively

Levels of Health Care

level description providers/settings

Primary Basic, Accesible, General practitioners, clinic,

comprehensive care community health center

Secondary Specialist care for more Specialist, district hospital

complex conditions

Tertiary Highly specialized, advanced Specialized hospital,

medical care university hospital
Equity in Health Development

●​ Equity in health and Development recommends ensuring more equitable access by the
poor to health care, education, jobs, capital, and secure land rights, among others.
●​ It also calls for greater equality of access to political freedoms and political power,
breaking down stereotyping and discrimination, and improving access by the poor to
justice systems and infrastructure

Summary

1.The Alma-Ata Declaration is the foundation— it set the global

vision that health is a human right and that Primary Health Care

(PHC) is the main strategy to achieve it.

2.Primary Health Care is the approach or method— it puts Alma-

Ata’s vision into practice by ensuring health services are accessible,

affordable, and community-based.

3.Equity in Health and Development is the goal— it’s the desired

outcome of implementing PHC as guided by Alma-Ata: reducing

unfair differences in health status and ensuring fairness in access.

Health Care System

Who pays for the cost of health care

52.7 - Private out of pocket

15. 3 - Local government

11.2 - National Government

8.9 - PhilHealth

7.1 - Private Insurance HMOs

4.8 Others
Philippine Health Budget

●​ 3.4 percent of the GDP ,

○​ lower than the prescribed 5 % by WHO
○​ Lower than Japan, India , (more than 6 %)
○​ Lower than Vietnam ( 5%)
●​ Government expenditure for Health is 30 per cent lower than half of Asian Countries

Amartya Sen

Noble prize winner

Economist

Even when the economy is poor, major health achievements can be achieved by using
resources in a socially productive way

Health Care System

the combination of resources, organization, financing and management that culminate in the
delivery of health services to the population.

In World Health Organization Report in 2000, health system was defined as “all the
organizations, institutions and resources that are devoted in producing health actions.

This includes efforts to influence determinants of health as well as more direct health-improving
activities.

A health system is therefore more than the pyramid of publicly owned facilities that deliver
personal health services

It includes, for example, a mother caring for a sick child at home; private providers; behavior
change programs; vector-control campaigns; health insurance organizations; occupational
health and safety legislation.

It includes inter-sectoral action by health staff, for example, encouraging the ministry of
education to promote female education, a well known determinant of better health

Goals and Function of Health Care System

3 main goals for health systems:

1. Improving the health of populations

2. Improving the responsiveness of the health system to the population it serves.

3. Fairness in financial contribution

Determinants of Health

Personal health Practices and coping skills

Health Servicwa

Biology and genetic endowment

Healthy child development

Education

Physical Environments

Employment and working conditions

Social support networks

Income and social status

Four Vital HEalth System Functions

Health Service Provision

Health Service Inputs

Stewardship

Health Financing

WHO Health System Framework

Service Delivery

Good health services are those which deliver

 ●​ effective,
●​ safe,
●​ quality
●​ personal and non-personal health interventions to those who need them, when and
where needed, with minimum waste of resources

Workforce

●​ A well-performing health workforce is one which works in ways that are responsive, fair
and efficient to achieve the best health outcomes possible, given available resources
and circumstances.
●​ There are
○​ Sufficient numbers and mix of staff, fairly distributed;
○​ They are competent, responsive and productive

Health Information System

A well-functioning health information system is one that ensures the

(1)production,

(2) analysis,

(3)dissemination and use of reliable and timely information on healthdeterminants,

healthsystems performance and healthstatus

Medical Products

A well-functioning health system ensures equitable access to essential medical products,

vaccines and technologies of assured quality, safety,efficacy and cost effectiveness, and their
scientifically sound and cost-effective use

Financing System

A good health financing system raises adequate funds for health, in ways that ensure people
can use needed services, and are protected from financial catastrophe or impoverishment
associated with having to pay for them

Leadership and governance

Leadership and governance involves ensuring strategic policy frameworks exist and are
combined with effective oversight, coalition- building, the provision of appropriate regulations
and incentives, attention to system-design, and accountability

Five Common Short Coming of Health Care Delivery

1. Inverse Care:

People with the most means, whose needs are less often consume care the most. Those with
the least means, with the greatest problems consume care the least.

2. Impoverishing care: (to deprive)

Wherever people lack social protection and payment for care is largely out of the pocket at the
point of service. They can be confronted with catastrophic expenses

3. Fragmented and fragmenting care:

– excessive specialization

– Narrow focus on disease control

– Health Care for the poor and marginalized

• Highly fragmented

• Severely under resources

– Development AID often aids in fragmentation

4. Unsafe care

Poor systems design is unable to ensure safety and hygiene standards leads to high rates of
hospital acquired infections, medication errors and other avoidable adverse errors

5. Misdirected care

Resource allocation cluster around curative services at great cost, neglecting the potential of
primary prevention and health promotion
Health care delivery system

Totality of all policies, facilities, equipment, products, human resources and services which
address the health needs, problems and concerns of the people . It is large, complex, multi-level
and multidisciplinary consisting of:

public sector

private sector

PHILIPPINE HEALTH CARE DELIVERY SYSTEM

“It is a complex set of organizations interacting to

provide an array of health services.”

(Dizon, 1977)

HEALTH CARE SYSTEM

Refers to an organized plan of health services (Miller-Keane, 1987)

HEALTH CARE DELIVERY

It is the rendering of health care services to the people (Williams-Tungpalan, 1981).

HEALTH CARE DELIVERY SYSTEM (Williams-Tungpalan, 1981)

This refers to the network of health facilities and personnel which carries out the task of
rendering health care to the people)

What is Primary Health Care?

At its heart, primary health care is about caring for people, rather than simply treating specific
diseases or conditions.

PHC is usually the first point of contact people have with the health care system. It provides
comprehensive, accessible, community-based care that meets the health needs of individuals
throughout their life.

This includes a spectrum of services from prevention (i.e. vaccinations and family planning) to
management of chronic health conditions and palliative care

Alma Ata Declaration (1978)

The Alma-Ata Declaration of 1978 emerged as a major milestone of the twentieth century in the
field of public health, and it identified primary health care as the key to the attainment of the goal
of Health for All.
“widespread inequities in health”

“Health for All by Year 2000

PHC according to the Alma Ata Declaration

It is intended to reach everybody, particularly those in greatest need; it is intended to reach to

the home and family level, and not be limited to health facilities; it is intended to involve a
continuing relationship with persons and families.

“HEALTH CARE FOR ALL

Goals of Primary Health Care

-​ Universal coverage
-​ Service delivery
-​ stakeholder participation
-​ leadership
-​ public policy

Essential Elements of Primary Health Care

●​ Adequate and safe water supply and basic sanitation.

●​ Immunization against major infectious diseases.
●​ Local endemic diseases control.
●​ Appropriate treatment of common diseases and injuries.
●​ Provision of essential basic medication

Essential Elements of Primary Health Care

●​ Expanded options of immunizations.

●​ Reproductive health needs.
●​ Provision of essential technologies for health.
●​ Health promotion.
●​ Prevention and control of non-communicable diseases.
●​ Food safety and provision of selected food supplements

Management of Primary Health Care

Role of Managers

Basic: Planning, Organizing, Staffing, Controlling, Directing

●​ Communication (D/O)
●​ problem solving and decision making (C)
●​ collaboration with other disciplines (O/P)
●​ people development (S)
 ●​ cost containment ©

Management of Primary Health Care

Health Care Managers usually carryout the following functions in the process of

management:

1. Planning

Managers are usually required to set a direction and determine what needs to be accomplished.
It means setting priorities and determining performance targets.

2. Organizing

This refers to the management function on designing the organization or the specific division,
unit, or service for which the manager is responsible. Further, it means designating reporting
relationships and intentional patterns of interaction. Determining positions, teamwork
assignments, and distribution of authority and responsibility

3. Staffing

This function refers to acquiring and retaining human resources. It also refers to developing and
maintaining the workforce through various strategies and tactics.

4. Controlling

This function refers to monitoring staff activities and performance and taking the appropriate
actions for corrective action to increase performance.

5. Directing

Its focus in to initiate action in the organization through effective leadership and motivation of,
and communication within subordinates

Philippine Health Care Delivery System through the Department of Health

Primary function:

Promotion, protection, preservation or restoration of the health of the people through the
provision and delivery of health services and through the regulation and encouragement of
providers of health, goods and services

Roles and Functions of the Department of Health

1.Leadership in health
• Serve as national policy and regulatory institution from which LGUs, NGOs and other
members of the health sector involved in social welfare and development will anchor their health
thrusts and directions

• Provide leadership in the formulation, monitoring and evaluation of national health policies,
plans and programs

• Serve as advocate in the adoption of health policies, plans and programs to address national
and local concerns

2. Enabler and capacity-builder

• Innovate new strategies in health to improve effectiveness of health programs, initiate public
discussion on health issues and undertaking and disseminate policy research outputs to ensure
informed public participation in policy decision making

• Exercise oversight functions and monitoring and evaluation of national health plans, programs
and policies

• Ensure the highest achievable standards of quality health care, health promotion and
protection

3. Administrator of specific services

• Manage selected national health facilities and hospitals that shall serve as national referral
centers, referrals for local health systems

• Administer direct services for emergent health concerns that require new complicated
technologies necessary for public welfare; administer special components of specific programs
in as much as it will benefit and affect large segments of the population

• Administer health emergency response service including referral and networking system for
trauma, injuries, catastrophic events, epidemic and other widespread public danger

DOH

Vision:

Filipinos are among the healthiest people in Southeast Asia by 2022, Asia by 2040

Mission:

To lead the country in the development of a productive, resilient, equitable and people-centered
health system for Universal Health Care
Level of Health Care and Referral System

National health services medical center teaching and training hositals

regional health services, regional medical centers, and training hospitals

Provinvial/city health services, provincial/city hospitals

Emergency/District Hospitals

Rural Health Unit, Comunity Hospitals and HEalth centers

Private Practitioners/Puercultutre centers

Barangay HEalth Stations

Levels of Health Care Facilities

1. PRIMARY HEALTH CARE FACILITIES

rural health units, their sub-centers, chest clinics, malaria eradication units, and schistosomiasis
control units; puericulture centers, tuberculosis clinics, private clinics, clinics operated by large
industrial firms, community hospitals, health centers and other health facilities

2. SECONDARY HEALTH CARE FACILITIES

non-departmentalized hospitals including emergency and regional hospitals

3. TERTIARY HEALTH CARE FACILITIES

medical centers and large hospitals

Three levels of primary health care workers

A. VILLAGE OR GRASSROOT HEALTH WORKERS

●​ first contacts
●​ socio-economic
●​ curative and preventive
○​ Community health worker, volunteers or traditional birth attendants

B. INTERMEDIATE LEVEL HEALTH WORKERS

●​ first source
●​ provide support
●​ attends to health problems
 ○​ Medical practitioners, nurses and midwives

C. FIRST LINE HOSPITAL PERSONNEL

●​ establish close contact

●​ backup health services
○​ Physicians with specialty, nurses, dentist, pharmacists, other health professionals

Primary Healthcare Service

includes routine care with a regular provider

urgent care for a minor health problem or accident

maternity and child care

disease prevention services

nutrition counseling

mental health care and referrals for home care

health promotion services

rehabilitation services

end-of-life care

Secondary Healthcare Services

provided by medical specialists

physician referral or self referral

cardiologists, urologists, dermatologists and other such specialists

services include acute care, short period stay in a hospital

emergency department for brief but serious illness.

psychiatrists, physiotherapists, respiratory therapists, speech

therapists and so on
Tertiary Healthcare Services

Inpatients-referral from primary or secondary health professionals.

advanced medical investigation and treatment

cancer management, neurosurgery, cardiac surgery and a host of complex medical and surgical
interventions

Advanced diagnostic support services and specialized intensive care

Classification of Hospitals (AO2012-002)

1.According to ownership

-Government/Public Sector

-Private Sector

2. According to Scope of Services

-General

-Specialty

3.According to Functional Capacity

-General

-Specialty

-Trauma Capability

1.According to ownership

-Government/Public Sector

Financed through a tax-based budgeting system

National:DOH (East Avenue Medical Center,Valenzuela

Medical Center,Tondo Medical Center)

Local:LGU(Val. Emergency Hospital,Malolos Provincial

Hospital)

-Private Sector
Financed through user fees

Hospitals

Clinics

Health Insurance

Medicine manufacturer

Vaccine maker

Researchers

. According to Scope of Services

-General Hospitals

Provide services for all kinds of

illnesses,diseases,injuries or deformities

Ex.QCGH,PGH,PCGH

-Specialty Hospitals

Specialize in a particular disease or condition in

one type of patient

According to illness: POC,SLH

According to organ: LCP,PHC,NKTI

According to group:PCH,NCH,Dr. Jose Fabella

Memorial Hospital

3. According to Functional Capacity

Services LEVEL 1 LEVEL 2 LEVEL 3

Clinical Services for Consulting specialists ll of level 1 plus: all of level 2 plus:
in-patients in:
Medicine Departmentalized Teaching/ Training
Pediatrics Clinical Services services with
OB-Gyne accredited residency
Surgey training program in
the 4 major clinical
services

Emergency and Respiratory unit Physical Medicine

out-patient services and Rehabilitation
Unit
Isolation Facilities General ICU

Durgical/Maternity High Risk Pregnancy Ambulatory Surgical

Facilities Unit Clinic

Dental Clinic NICU Dialysis Clinic

Ancillary Services Secondary Clinical Tertiary Clinical Lab Tertiary lab with hispa
lab

Blood Station Blood Station Blood Bank

1st level x-ray 2nd level x-ray with 3rd level X-ray
mobile unit

Pharmacy Pharmacy Pharmacy

Types of Laboratory

According to Functions

Clinical Pathology Anatomic Pathology

Hematology Surgical Pathology

Clinical Chemistry Immunohistopathology

Microbiology Cytology

Parasitology Autopsy

Mycology Forensic Pathology

Clinical Microscopy
Immunohematology

Immunology/Serology

Blood banking

Laboratory Endocrinology

Toxicology and Therapeutic Drugs

Monitoring

According to Institutional Character

Hospita;-based Non-hospital-based

kab that operated within the hospital operates in its own

Accordig to Service Delivered

Primary Secondary Tertiary

1. Routine 1. Primary Category 1. Secondary Category

hematology laboratory examination laboratory

2. Routine urinalysis 2. Routine Chemistry 2. Special chemistry

3. Routine fecalysis 3. Quantitative platelet 3. Special hematology

4. Blood typing count 4. Immunology/Serology

4. Crossmatching 5. Microbiology

5. Gram staining/KOH

Point or Reference Primary Secondary Tertiary

 1.​ Examination
performed 1. Routine 1. Primary laboratory 1. Secondary
hematology laboratory
examination
2. Routine urinalysis examination
2. Routine chemistry
3. Routine fecalysis 2. Special chemistry
3. Blood typing and
4. Quantitative 3. Special
platelet crossmatchin hematology

determination 4. Immunology/
Serology

5. Microbiology

2.​ Minimum 10 sq. m 20 sq. m 60 sq. m

Space
required

3.​ Minimum
Facilities 1. Clinical centrifuge 1. Primary laboratory 1. Secondary
required laboratory
2. Hemacytometer equipment/
instruments equipment/
3. Microhematocrit instruments
centrifuge 2. Refrigerator
2. Incubator
4. Microscope with 3. Photometer
OIO 3. Trip/Analytical
4. Water bath balance
5. Hemoglobinometer
5. Timer 4. Rotator
6. Differential blood
cell counter 5. Serofuge

6. Autoclave

7. Drying oven

8. Biosafety cabinet

Philippine Health System

1979: Adoption of Primary Health Care

Promoted participatory management of the local health care system.

1982: Reorganization of DOH

Integrated public health and hospital services.

1988: The Generics Act

Prescriptions are written using the generic name of the drug

1991: RA 7160 "Local Government Code"

Transfer of responsibility of health service provisions to the local government units.

1995: National Health Act

Aims to provide all citizens a mechanism for financial protection with priority given to the poor.

1996: Health Sector Reform Agenda

2005: FOURmula One (F1) for Health

Adoption of operational framework to undertake reforms with speed, precision, and effective
coordination.

2008: RA 9502 "Access to Cheaper and Quality Medicines Act"

Promote and ensure access to affordable quality drugs and medicines for all.

2010: AO 2010-0036 "Kalusugang Pangkalahatan"

Universal health coverage and access to quality health care for all Filipinos.

2013:Sin Taxes for Health

Generating extra revenue for the DOH by discouraging harmfulconsumption of alcohol and
tobacco.

2019: Universal Health Care Law

Enrolling Filipino Citizens automatically in the National Health Insurance Program administered
by Philhealth

Directions of the Philippine Health Sector

●​ The Philippine Health Agenda (DOH Administrative Order 2016-0038)

●​ The Philippine Developmental Plan 2017-2022
●​ NEDA AmBisyon Natin 2040
 ●​ Sustainable Developmental Goals 2030

Philippine Health Care Delivery System

It is a complex set or organization interacting to provide an array of health service

Public Private
Largely financed through tax-based system Largelt market-oriented

National Local Profit Non-profit

DOH LGU Commercial, market Non-commercial,
orientation service-orientation
Specially retained Provincial and district
and regional hospitals, RHUs, Private practitioners, Socio-civic groups,
hospitals medical BHSs private clinic and religious
centers, DOH laboratories organizations or
Representatives foundations